Oral Cancer
Research Project
PREAMBLE
T he Saveetha Medical
and Educational Trust is a Charitable trust registered under the TamilNadu Societies
Registration Act 1975 (TamilNadu Act 27 of 1975) and established in 1986 to render medical
relief, to promote education and to encourage Medical Research projects. To provide medical relief, Saveetha hospital was
started at Erode in 1986 with the most modern and sophistical equipments and all the
speciality departments which cater to the poor and middle class people in and around
periyar District. To promote education,
Saveetha Dental College and Hospitals was started at Chennai in the year 1988.
Now to encourage Medical Research, the Trust has decided to undertake Research projects at
the Saveetha Dental College Hospitals, Chennai, with the expertise of experienced senior
professors and vast Clinical materials available in the college.
 Saveetha Dental
College and Hospitals is a full fledged dental institution conducting B.D.S and M.D.S
Courses and running Dental Hospitals with all speciality departments in dentistry with a
100 bedded general hospital for catering to the need of dental students to study medicine,
surgery and allied subjects and extend free medical services to the rural population with
medical, surgical, pediatrics and gynaecological treatment etc.,. This institution is
recognized by the Dental Council of India, New Delhi, affiliated to the Tamilnadu DR.
M.G.R. Medical University, Chennai, India and approved by Govt. of Tamilnadu and also by
the Royal College of Surgeons of Glasgow, U.K for training in FDSRCS & MFDRCS. The Institution is run and managed by Saveetha
Medical and Educational Trust under the direct administrative control of Trust President
DR.N.M. Veeraiyan, who is also a dental surgeon.
 The trust has
proposed to conduct research on pre cancer with well experienced Senior Professors and
Staff members who are interested in research activities and create facilities for a
research center and a hospital exclusively for oral cancer, a first of its kind in India,
with an outlay of Rs. 16 Crores.
Oral cancer, the dreaded disease has high morbidity rate compared to other oral
diseases . It is estimated that over 7 lakh
people develop oral cancer annually. As per
the National Cancer Registry Program it can be expected that there will be over one lakh
and fifty thosand oral cancers in India by the dawn of the 21st Century. In Tamilnadu, majority oral cancer patients have
the habit of betelnut, betel leaf and tobacco chewing habit. This is not only as a habit but also a custom for
auspicious functions. It has been proved
scientifically that the use of pan masala with Zarda, gutka have direct relation to the
genesis of pre cancer and oral cancer in mouth. The Rural
population is still not aware of the dangerous complication of tobacco chewing, and
becomes victim to oral cancer. Oral Cancer
also develops as secondarily from a primary cancer elsewhere in the body.
Pre cancer in the cavity may be a lesion or condition. Pre cancer in the mouth takes long time to turn
into cancer.
 A Pre cancerous
lesion is a morphologically altered tissue in which cancer is likely to develop. Some of the important Pre cancerous lesions
include leukoplakia and palatal changes related to reverse smoking. The prevalence of leukoplakia is higher in persons
who are betal tobacco chewers and smokers. (6.1%). In general the prevalence of leukoplakia is 1.8%
in tobacco users as compared to 0.03% in non tobacco users.
Malignant transformation of pre cancerous lesions ranges from 0.03 to 17.5%.
Pre cancerous conditions: These are
conditions of systemic nature associated with risk of cancer in mouth. Atrophic glossitis due to anaemia, syphilis and
submucous fibrosis are some conditions that are likely to change into carcinoma.
 The methods of
evaluation for Oral cancer and Pre cancer include epidemiological, clinical
histopathological, cytological, histochemical, biochemical and cell proliferation studies,
DNA histograms and the study of tumour associated antigenic constituents - viz tumour markers.
The present research has been aimed to include evaluation methods on Oral cancer
and pre cancer.
In spite of thousands of studies going on all over the world, the exact causes of cancer
are not discovered and as the cause is not known, no definite therapy has been found to
treat cancer. Though science is still dark
concerning the etiology of cancer, commendable research including advanced gene therapy is
going on all over the world and this Trust has decided to take part in that noble
venture of doing basic research followed by advanced research in oral cancer.
A : PROJECT CENTRE:
The research will be
conducted in Saveetha Dental College and Hospitals and the subjects will be the people of
Tamilnadu and the biological materials would be collected from the rural population,
factory workers, conservancy workers and last grade workers available in the city of
Chennai and neighbouring villages in Kancheepuram and Thiruvallur districts. Neighbouring research institutes like CLRI, Indian
Institute of Technology are likely to be involved for expert opinions in the research
activity.
B:SAMPLE
SIZE: 1,00,000
population for research.
C : ESTABLISHMENT OF RESEARCH INSTITUTE AND ORAL CANCER
HOSPITAL: Though
the research is to be started in the Saveetha Dental College, it would be carried out in a
full fledged Research Institute attached with a 100 bedded Oral cancer hospital.
As a pre requirement for the research a new building for the Research Institute and
exclusive Oral cancer Hospital, fully equipped for modern multi modality therapy, is
to be constructed in the available land of the Trust.
The details are as below.
Research
study outline
1.Aim
The
research is an attempt to identify the etiopathogenesis of oral cancer, the mechanism of
malignant transformation of pre cancer and institute suitable modalities in the treatment
of pre cancer and oral cancer both by therapeutics and surgery.
2.Objectives:
1.
To record the incidence of pre-cancer and oral cancer with reference to age, sex and
occupation in target populations who are prone to develop oral cancer.
2. To record the incidence of betelnut chewing, betelnut with betel leaf chewing,
betelnut-betel leaf and tobacco chewing, pan masala chewing, smoking and alcoholic habits.
3. To record the incidence of oral cancer among the betelnut chewers, nut and leaf
chewers, nut-leaf and tobacco chewers, smokers and alcoholics.
4. To record the observation of changes of pre-cancer to oral cancer over certain periods.
5. To study the microscopical appearance of the various pre-cancerous lesions and the
potentiality of changing into cancerous lesions under H& E Stain and special stains
and cytological study.
6. To study the microscopical appearance of various carcinomas of oral cavity and study
the immunological aspects.
7.
To establish the clinical varieties of pre-cancer and oral cancer.
8.
To establish the bio-chemical variations in pre-cancer and oral cancer with reference to
sugar, albumin, zinc,copper levels in urine.
9.
To establish serum proteins like total protein, AG ratio, Protein-electro phoretic changes
for molecular oral cancer.
10.
To establish the changes of serum zinc, selenium, iron, copper.
11.
To establish the variations of anti-oxidative enzymes, superoxide dismutase, catalase, peroxidase, and aldolase in pre-cancer
and oral cancer.
12. To establish the alteration of non-enzymic antioxidants like vitamin A.C.E and
Glutothione.
13. To establish lipid peroxidation changes in pre-cancer and
oral cancer.
14. To establish microscopical changes of pre-cancer and oral
cancer with reference to smoking and chewing habit and to establish the malignant
transformation of pre-cancer to oral cancer to find out the exact cause which transforms
pre cancer to cancer.
15. To establish the effect of controlling the pre cancer changes into cancer by
chemoprophylaxis.
16. To establish the newer surgical technique and modalities.
17. To find out the carcionogenic ability in pan masala, gutka, zarda and record the
mucosal changes on application of pan masala by animal experiment.
18. Running a exclusive oral cancer Hospital-multi modality therapy.
3.Methodology:
1. Dental health camps have to be organized
with the help of social workers
of cancer research team by the Department of Community Dentistry for the rural population,
factory workers and working population who are considered as target population to develop
cancer.
2. Team of doctors who have trained in the subject of oral cancer in orientation programs
would accompany and survey population and record relevant information as per the coded
proforma. This survey includes history taking
and recording clinical findings of pre cancer and oral cancer.
3. Trained doctors under the guidance of an expert would visit the cancer hospitals and
record the findings of oral cancer and pre cancer for clinical evaluation.
4. Samples of blood, urine and tissues of pre cancerous and cancerous lesions would be
collected from those detected during the cancer survey and from various hospitals and it
will be stored in the college in the research department.
5. Histopathological study will be carried out by H & E section and special stains for pre-cancer and oral cancer and
exfoliative cytology works would be carried out.
6. Samples of blood collected from pre cancer and cancer patients would be subjected to
biochemical analysis for enzymes, trace elements and
metals.
7. Patients with pre cancerous condition, particularly leukoplakia,
could be treated with chemoprophylaxis and observations would be made.
8. Surgical management of pre-cancerous conditions and early cancers would be carried out
to plan newer modalities in oral surgery as reconstructive surgical therapy.
9. Chemical analysis of different types of
betelnuts, pan masala, pan with zarda, gutkha etc, would be carried out to identify the
carcionogens.
10. Animal experiments with rabbit as animal model , for application of pan masala on
rabbit mucosa and observations for any clinical changes
for pre cancer and oral cancer would be recorded.
| 4. RESEARCH TEAM: Name of
individual |
Experience |
| 1. Promoter & Chief Advisor
Dr. N. M. Veeraiyan
President
Saveetha Medical And Educational Trust. |
( Administrative )
33
years |
| 2. Scientific Advisor
Dr. C.K. Dhanasekaran
Director of Post-Graduates Studies,
Saveetha Dental College & Hospitals. |
( Clinical & Teaching )
42
years |
| 3. Head of Research Institutions
Dr. M.F.Baig
Dean
Professor of Oral & Maxillofacial Surgery,
Saveetha Dental College & Hospitals. |
37 years |
| 4. Project In Charge
Dr. N. Gnana Sundaram, M.D.S
Professor of Oral Medicine & Radiology,
Saveetha Dental College & Hospitals. |
36 years |
| 5. Coordinators
Dr. N. Gnana Sundaram, M.D.S
Professor of Oral Medicine & Radiology,
Saveetha Dental College & Hospitals. |
36 years |
| 2. Dr.
T.Chandrasekar
Professor of Oral Pathology & Microbiology |
20 years |
| 3. Dr.
N.D. Jayakumar
Professor of community Dentistry |
15 years |
|
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Experts
Dr. C.K. Dhanasekaran
Director, Post Graduate Studies
Dr. Babu Mathew
Professor, Community Oncology
Regional Cancer Centre, Trivandrum
Dr. Salim Thomas
Surgical Oncologist
Professor of Surgery
Saveetha Dental College & Hospitals
Dr. S.V. Kumarasamy
Asst.Professor, Dept. of Oral And Maxillofacial Surgery
Kidwai Medical Cancer Institute, Bangalore.
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Conclusion:
The outcome of research would clearly give
the incidence of pre-cancer and cancer and various aspects of clinical varieties. Histopathology will give different varieties of
cellular changes in different habits. Bio-chemical
studies will give different varieties of enzyme changes.
Surgical and experimental research would be used as a basis upon which advanced
research like histochemistry, immunocytochemistry, chromosomal and gene study therapy could be conducted to reach
the ultimate goal of discovery of the cause of cancer and treatment of cancer. Facts and figures would also propagate the message
for public in prevention and control by proper planning.
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